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Mechthild Meyer (Gentium Consulting) Alma Estable (Gentium Consulting)

Mechthild Meyer (Gentium Consulting) Alma Estable (Gentium Consulting) Laurie Gibbons ( The Public Health Agency of Canada ) www.gentium.ca. Critical Assessment of Type 2 Diabetes Prevention Interventions in Canada: Finding a path through the evidence labyrinth.

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Mechthild Meyer (Gentium Consulting) Alma Estable (Gentium Consulting)

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  1. Mechthild Meyer (Gentium Consulting) Alma Estable (Gentium Consulting) Laurie Gibbons (The Public Health Agency of Canada) www.gentium.ca Critical Assessment of Type 2 Diabetes Prevention Interventions in Canada: Finding a path through the evidence labyrinth

  2. What we hope you will take away • What works: Know evidence-based components for lifestyle interventions to prevent type 2 diabetes • An approach: A way to map out the components of these interventions

  3. Imagine this… • Your role: Program planner (chronic disease prevention) at a health department (HD) • Context: HD in a mid-size town, main employer: paper mill • Public Health Standard Requirement: Develop programs that are ‘evidence-based' • Chronic Disease Prevention: Reduce obesity, pre-diabetes • HD strategic goal: Decrease percentage of the adult population with pre-diabetes (obese, overweight) by 2% over the next ten years • HD target: Hard to reach adult population, especially males

  4. Where to start …. assessing the effectiveness of interventions • Lifestyle and environmental interventions resulting in lasting behavioural change • You heard that most focus on reducing weight or preventing weight gain through • Physical activity • Dietary behaviour Hunch/Myth or evidence?

  5. Looks familiar?

  6. Assessing the effectiveness of type 2 diabetes interventions Systematic Reviews, Syntheses • What part of the intervention makes it effective? Multiple combinations of intervention components

  7. What does the evidence say? Evidence contradictory and limited: • Lifestyle interventions are as effective as pharmaceutical interventions to reduce the rate of progression to type 2 diabetes • Effective components: • Intensive low-fat diets + exercise + counselling • “Mediterranean” diet combined with behaviour therapy • Types of effective lifestyle interventions are: • Sustained, long-term, intensive, multicomponent

  8. What does the evidence say? Diet-onlyinterventions Exercise-only interventions Some reduce weight Long-term follow-up: no evidence in diabetes risk reduction Increase physical activity, e.g., walking Limited evidence: changes last Insufficient evidence: reduce risk factors for diabetes • Combined interventions • Evidence: Diet + Exercise + psych. support reduce incidence of type 2 diabetes in high risk groups (pre-diabetes or metabolic syndrome)

  9. Intervention Components • Education • Counselling Multiple Intervention Components • Diet Modification • Physical Activity Modification • Devices • Environment, policy change

  10. What is an Intervention? What: components (i.e., diet, PA) Interventions are complex with many different components Approach: activities (i.e., course, counselling) How: delivery (i.e., online, in person) Who: intermediaries (e.g., teacher, dietician) Where: setting (e.g., school, workplace) Timing: length (e.g., 3-months, follow-up)

  11. Interventions may include a variety of components

  12. Example: POWER - Preventing Obesity Without Eating like a Rabbit (Australia) • What: change in nutrition, physical activity • Where: Workplace, target: overweight, obese, male, blue collar shift workers • Approach: One educational informationsession (behaviourchange strategie, monetary incentives) • How: Weight loss handbook, pedometer • Website: online support • Self-weighing each week • Email feedback by professionals • Who: Delivered by trained staff • Timing: 14 weeks with follow-up

  13. POWER - Evidence (outcomes) • After 14 weeks participants had lost significantly more weight (on average 4.3 kg), about 5% of their baseline weight, than controls • Significant effects on waist circumference, BMI, systolic blood pressure, resting heart rate and physical activity. • Only 28% of men in the intervention group used the online component of the intervention, but those who did lost most weight Source: Morgan et al. (2011). Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. Prev Med, 52(5), 317-325.

  14. Example: POWER

  15. Example: POWER

  16. Conclusions • Mapping out intervention components may make it easier to know what combination lead to the ‘evidence’ (desired outcomes) • Knowing the components facilitates program planning Program planners can be more confident that their program is evidence-based

  17. Thanks! For more information: • Mechthild Meyer: meyer@gentium.ca • Alma Estable: estable@gentium.ca • Laurie Gibbons: laurie.gibbons@phac-aspc.gc.ca Gentium Consulting: www.gentium.ca The Public Health Agency of Canada

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